Diagnostic Value of Cell Block Method in Ascites Fluid of Ovarian Cancer

Abstract

Introduction: The traditional studies documented that peritoneal washing cytology in ovarian tumour could detect a subclinical intraperitoneal extension effectively though, they didn’t mention the detailed methodological technique for it. In conventional Cytological Smears (CS), identification of malignant cells has occasionally posed a diagnostic problem, whereas there are some studies corroborating that undetermined malignancies on CS showed conclusive diagnosis with the aid of Cellblock (CB) preparation. Aim: To assess and compare the accuracy of CB method in the cytological diagnosis of ascites in ovarian cancer with CS. Materials and Methods: All ovarian cancer specimens for cytopathology consisting of both CS and CB over a 4-year period were reviewed and analysed. The available specimens from 64 cases were compared on sensitivity and yield for malignancy by histologic type. Results: The overall sensitivity of CS (91%) was almost the same as CB (95%). However, the yield for malignancy could be improved by 6.3% (4/64) when CB were utilised together. The same trend is noted on high grade serous (100% vs 100%; N=27) and clear cell carcinoma (100% vs 92%; N=17) though no improvement on definitive cytologic conclusion for malignancy was observed. Whereas, in endometrioid carcinoma (N=11), the sensitivity of CS (20%) was remarkably inferior to CB (80%) and the yield for malignancy on CS alone (8.2%; 1/11) was significantly improved to 45.5% (5/11) (p=0.048) when CB was combined with CS. More importantly, all four cases exhibiting negative CS with positive CB showed endometrioid carcinoma with endometriosis comorbidity. Conclusion: These findings strongly suggest that, compared to CS alone, CB technique along with CS provided significant improvement on the yield for malignancy specifically in endometrioid carcinoma.

Keywords

• endometrioid carcinoma
• endometriosis
• false negative
• sensitivity
• staging